From the Archives
A Manual of Cranial Technique
Prepared by Rebecca Conrow Lippincott, DO and Howard A. Lippincott, DO
Approved by William G. Sutherland, DO, Author of The Cranial Bowl
Copyright 1943, 1946, 1948; Academy of Applied Osteopathy
Reprinted, 1995; The Cranial Academy, Inc.
Preface to the Second
Edition of A Manual
of Cranial Technique
This text was originally compiled by
the authors in 1943 from material sup-
plied by Dr. William G. Sutherland and
from his treatise, The Cranial Bowl,
which was published in 1939. The
Academy of Applied Osteopathy, an
affiliate of the American Osteopathic
Association, sponsored the first print-
ing of The Manual, which was distrib-
uted by a cranial committee of the
Academy, consisting of Doctors
Rebecca C. Lippincott, Kenneth E.
Little, and Richard B. Gordon, chair-
man. After the organization of the Os-
teopathic Cranial Association in affili-
ation with the Academy of Applied
Osteopathy the distribution was con-
tinued by the O.C.A. Upon exhaustion
of the original edition this reprint was
accomplished by the Osteopathic Cra-
nial Association through its Publication
Committee. The book is primarily de-
signed for the use of those who have
studied under Dr. Sutherland and is not
intended as a complete exposition of
his cranial concept.
Further material given out by Dr.
Sutherland and a fuller understanding
of cranial osteopathy make it possible
to add to the original text and advis-
able to make some deletions.
Rebecca C. Lippincott, DO
Howard A. Lippincott, DO
Authors
Summer 2003
Foreword
Dr. William G. Sutherland, origi-
nator of the cranial concept and au-
thor of The Cranial Bowl, frequently
opens his course in cranial osteopa-
thy with the following quotations
from Doctor Andrew Taylor Still:
“An osteopath reasons from
his knowledge of anatomy. He
compares the work of the abnor-
mal body with the normal body.”
“The osteopath has his own
symptomatology.”
“We must know the position
and purpose of each bone, and
be thoroughly acquainted with
each of its articulations. We
must have a perfect image of the
normal articulations that we
wish to adjust.”
To these quotations, Dr. Sutherland
adds: “The reciprocal tension mem-
branes are continuously under tension
during both inhalation and exhalation.
They are like a tense wire stretched
between two upright poles. One may
pull on one pole and the tense wire
pulls the other pole in the same di-
rection, and vice versa. The techni-
cian through his finger tips is continu-
ally seeing, thinking, feeling, guiding
– to the point of articular release.”
Acknowledgments
T.L. Northup, DO, for encourage-
ment and suggestions gained through
his years of experience as Secretary and
Treasurer of the Academy of Applied
Osteopathy, formerly known as Osteo-
pathic Manipulative Therapeutics and
Clinical Research Association.
Mary Alice Hoover, DO, and Mrs.
William G. Sutherland for assistance
in editing and proofreading.
Ralph W. Rice, DO, for photo-
graphs illustrating technique.
Applications
of Technique
Intracranial pressure and power,
which include the brain and the fluc-
tuation of the cerebrospinal fluid, are
very strong. They exert the pull on
the “falx” and the “tent” to normal-
ize the position of the cranial bones.
Apply and release all pressures
slowly and gradually. ➻
The AAO Journal/13
 QUESTION: For correction, when
do we use direct action and when do
we exaggerate the lesion?
ANSWER: (By W.G.S.) “Direct
action is contraindicated wherever it
is possible to exaggerate the lesion.”
DIRECT ACTION IS USED IN:
1. Cant Hook technique for Spheno-
Frontal L-shaped area.
2. Parietal Spread.
3. “V” Technique for releasing fixa-
tion of the temporal when the pe-
trous portion is in external rotation.
4. Parieto-Occipital (Traumatic).
Possibly others –
QUESTION: Should care be ex-
ercised in application of technique?
Can too much force be harmful?
ANSWER: “The Cranium is a very
delicate structure. It should be
handled with the greatest possible
care, based on a thorough understand-
ing of its mechanics. The motive
power is created by the use of natural
forces within the body, with the
patient’s cooperation. Thus, a tech-
nique that is gentle and without force
is used in normalizing the position of
the cranial structure.”
Technique of Directing
the Potency of the
Cerebrospinal Fluid
Not until the years 1947 and 1948,
did Dr. Sutherland describe and ex-
plain this technique for the diagnosis
and correction of cranial membranous
articular strains or lesions. He wisely
withheld it until his followers were
ready to comprehend it through expe-
rience with and understanding of his
cranial concept. The method makes use
of the unexplainable, but nonetheless
actual, inherent capacity of the cere-
brospinal fluid to perform the work
assigned to it. The ease and effective-
ness of cranial osteopathy is increased
14/The AAO Journal
immeasurably by this technique.
A fluctuating movement or trans-
ference of energy within the skull by
means of the cerebrospinal fluid is
initiated by applying a gentle pressure
upon the cranium. A point of appli-
cation is selected on the opposite side
and at as great a distance from the area
to be affected as is convenient. The
pressure is directed toward that area,
regardless of the bony or soft tissue
structures, which intervene. Only a
few ounces of pressure will suffice
and the best results follow a decrease,
rather than an increase, in the amount
of pressure used during the operation.
Usually after only a few seconds an
intermittent wavering motion and a
tendency to expansion of the bony
wall is felt by the palpating fingers
indicating that the energy is being
transmitted to the desired point.
When used in the diagnosis of le-
sions the energy is directed toward an
articulation. Normal structure re-
sponds with a perceptible resilience,
quite different from the distinct wa-
vering or beating sensation felt in case
there is limited motion or fixation of
the articulation.
In applying the technique for the
correction of lesions the involved
structures are held at the point of bal-
anced membranous tension and ar-
ticular release, usually in exaggera-
tion of the lesion position, while the
energy is directed toward the articu-
lation. The potency of the fluid en-
ergy is increased by dorsiflexion of
the patient’s foot on the side oppo-
site the lesion, or both feet in case the
lesion is in the midsagittal plane. Fre-
quently a definite release at the site of
lesion is palpable and following the
reduction the fluctuating pressure
against the osseous structures subsides.
In acute traumatic lesions and in
children before the sutures have de-
veloped the adult type of articular
surfaces it is advisable to use the “di-
rect action: method of holding the
structures in a position toward their
normal relationship. Sometimes
simple disengagement or tendency to
separation of the articular surfaces is
adequate for correction by the cere-
brospinal fluid technique. Molding of
distorted bones is accomplished by
using light pressure toward a restora-
tion of the normal shape of the bone,
the plastic change being made by the
fluid cooperation.
This technique is powerful and
specific. It supplements and to a de-
gree replaces respiratory cooperation
by using the inherent capacities of the
cerebrospinal fluid.
Primary Respiratory
Mechanism and it’s
Relation to the
Circulatory Activity of
the Cerebrospinal Fluid
The primary respiratory mecha-
nism, to which the diaphragmatic res-
piratory mechanism is secondary, in-
cludes the brain, the intracranial
membranes, the cerebrospinal fluid
and the articular mobility of the cra-
nial bones. It also includes the spinal
cord, the intraspinal membranes, the
same cerebrospinal fluid and the ar-
ticular mobility of the sacrum be-
tween the ilia. (Note, particularly, the
articular mobility of the sacrum be-
tween the ilia, which is involuntary
mobility – and not mobility of the ilia
upon the sacrum, which is a postural
mobility.)
There are no muscles of attach-
ment from the sacrum to the ilia. Nei-
ther are there muscles of attachment
from bone to bone to operate the cra-
nial articulations. The cranial struc-
ture as well as the sacrum is involun-
tary in activity and does not require
muscular agencies of profusion.
During the primary respiratory
functioning, the brain, using power-
ful energy from within itself, operates
through an expansion and contraction
of the cerebral and cerebellar hemi-
spheres. This is, of course, minimal.
During inhalation these cerebral
Summer 2003
hemispheres, like the wings of a bird,
swing upward, the third ventricle di-
lates and lifts the pituitary body,
which strong dural membranes an-
chor to the sella turcica. This lifting
of the sella turcica, or slight raising
of the saddle, tips the anterior end of
the sphenoid bone downward into a
“nose dive”.
At the same period the reciprocal
tension membrane consisting of the
falx cerebri and the tentorium
cerebelli, acting somewhat as a check
ligament allows the ethmoid to drop
downward and lifts the petrous por-
tions of the temporal bones into ex-
ternal rotation and the spheno-basi-
lar articulation into the position of
flexion. Also, at the same period, the
spinal cord is drawn upward and
through the operating of the intraspi-
nal membrane the sacrum is drawn
upward and posterior between the ilia.
Note: The intraspinal mem-
branes are hung from above at the
foramen magnum and the upper
two or three cervical vertebrae and
have only one attachment below–
at the sacrum.
During the period of exhalation
some of the activities are as follows:
The cerebral hemispheres, like wings,
fold and the third ventricle contracts,
which allows the pituitary body to
drop the sella turcica down thus tip-
ping the anterior end of the sphenoid
upward. At the same time the recip-
rocal tension membrane, acting
somewhat like a check ligament, lifts
the ethmoid upward and allows the
sphenobasilar junction to drop down-
ward into the position of extension.
This allows the petrous portions of
the temporal bones to drop downward
into internal rotation. During this pe-
riod the spinal cord moves down-
ward, and the intraspinal membrane
drops the sacrum anteriorly between
the ilia.
According to Hilton in his text
Rest and Pain, “the brain rests upon
Summer 2003
water beds of cerebrospinal fluid. It subarachnoid spaces permitting cir-
seems not only to rest but to rock its culation of cerebrospinal fluid from
cranial articular cradle through the one to the other. This anatomical fact
fluctuation of the cerebrospinal is used together with compression of
fluid.” the bulb, a description of which fol-
Dr. Still stated, “The rule of the lows, to bring systemic ailments un-
artery is supreme.” Cranial theory der direct control by sending the cere-
adds, “The cerebrospinal fluid is in brospinal fluid fluctuating up into the
command” –being primary to arte- ventricles, down into the spinal ca-
rial, venous and lymphatic activity. nal and out into the subarachnoid
A complete picture of the intracranial spaces surrounding the brain and spi-
and intraspinal membranes and of the nal cord.
large body of cerebrospinal fluid is
essential. It is through the agency of (a) OCCIPITAL SPRING
these membranes, acting as check POSITION: Patient supine-opera-
ligaments during respiration that the tor at head. Thenar eminences are
fluctuation of the cerebrospinal fluid placed on lateral angles of the occipi-
is brought about. tal bone.
The cerebrospinal fluid is under
pressure and constant activity, both MOTION: Fingers interlaced for
within the ventricles and spinal cord F.D.P. and F.L.P. tension, which is
and surrounding the brain and spinal maintained throughout deep expira-
cord. It is the very center of body ac- tion held to involuntary inspiration.
tivity. It fluctuates, during the cycles
of respiration (according to Best and NOTE: This springs the edges in-
Taylor). It is an interchange with the ward and flexes the structure of the
arterial blood at the choroid plexuses. occiput where it under rides the pari-
It empties into the venous system. etals. Pressure is light at first, gradu-
In the roof of the fourth ventricle ally increases on subsequent expira-
there are three openings – a medial tions until involuntary jerk is obtained
and two lateral – by means of which and “motor is idling.” The diaphragm
the ventricle communicates with the ➻
Compression of the Bulb
The articular surface of the superior portion of the mastoid angle
of the occipital bone is beveled so that the occiput circumducts
upward and forward under the parietals while the lateral portion
moves up and forward between mastoid portions of the temporal
bones.
The AAO Journal/15
has slowed down to the short motion
of a pump and all fluids are changed
. angles inward.
(b) OCCIPITAL SPREAD
POSITION: Patient supine-opera-
tor at head. Thenar eminences placed
over mastoid angles of parietal bones;
fingers locked over the occipital pro-
tuberance.
MOTION: Maintain compression
of the mastoid angles during com-
plete exhalation until the involuntary
jerk and inspiration.
NOTE: This spreads the outer
edges of the occipital bone over the
lateral sinuses.
(c) OCCIPITAL FLATTENING
POSITION: Patient supine-opera-
tor at head. Thenar eminences are
placed on lateral angles of occipital
bone.
MOTION: Pressure is exerted on
occipital protuberance by the fingers
to spread the edges outward flatten-
ing the bulb anteroposteriorly.
(d) SACRAL COOPERATION
(1) POSITION: Patient supine-
operator at head. Sacrum of patient
is held in position of expiration by a
pad placed under the base, while cra-
nium is held in position of inspira-
tion as follows: The parietal angles
are held by vault lift with contact over
posterior-inferior angles and surfaces
while thumbs are hooked over the
sagittal suture.
MOTION: Operator maintains
this position while patient breathes
normally. (This is not associated with
any additional respiratory effort on
part of patient and operator must not
exaggerate any motion of head.)
(2) POSITION. Patient supine –
operator at head. Sacrum of patient
is held in position of inspiration by a
pad placed under the apex. Cranium
16/The AAO Journal
is held in position of expiration by
holding the posterior inferior parietal
MOTION: Operator maintains
position of expiration (extension) on
cranium while the patient breathes
normally.
(3) Head may be held in position
of inspiration by flexing sphenobasi-
lar to point of articular release.
(4) Head may be held in position
of expiration by extending sphe-
nobasilar to point of articular release.
Note: Pad under sacrum must al-
ways maintain it in opposite position;
i.e., head in position of inspiration
(flexion) while sacrum is in position
of expiration or vice versa.
(5) If unable to compress the bulb,
rock sacrum between ilia in time with
respiratory period. Sacral cooperation
technique brings the respiratory pe-
riods to point where “the motor is
idling” or time of inspiration and ex-
piration is nearly equal-membranes
acting as check ligaments.
WARNING: Pad under apex of
sacrum affects the lumbar curve and
may cause pains if kept there too
long.
(e) POSTURAL COOPERATION
POSITION: Patient supine-opera-
tor at head, assistant at feet. If no as-
sistant is available have patient use
own muscle force.
(1) Assistant holds the feet in plan-
tar flexion with toes in, rotating the
thighs internally. The patient attempts
to press the lumbar spine against the
table obliterating the lumbar curve.
Operator holds the cranium in the
position of extension during several
respirations.
(2) Assistant holds the feet in dor-
siflexion and external rotation. The
patient flattens the lumbar spine
against the table as described above.
Operator holds the cranium in the
position of flexion during several res-
pirations.
ACTION AND IMPORTANCE OF
COMPRESSION OF THE BULB
Compression of the bulb:
(1) Tenses the tentorium cerebelli
thereby causing alternate compression
and release of the fourth ventricle. This
stimulates the vital centers, which are
located on or near its floor.
(2) Incites a fluctuant wave in the
cerebrospinal fluid.
(3) Changes the circulation to the
brain and spinal cord.
(4) Changes all body fluids.
CEREBROSPINAL FLUID
(Must never be overlooked)
Low back conditions produce pro-
found disturbances in the circulation
of the cerebrospinal fluid.
Pelvic lesions frequently cause re-
flex disturbances in the head due to
restricted movement of the cere-
brospinal fluid.
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Summer 2003
 SACROILIAC LESIONS IN RE-
LATION TO CRANIAL LESIONS
Each will cause the other and ad-
justment of the cranium will aid in
maintaining free motion of the
sacrum.
Reciprocal Tension
Membranes
From Cranial Bowl – Page 45
In describing spinal lesions, the
author prefers the term: ligamentous
articular strains; and for cranial le-
sions: membranous articular strains.
The spinal lesion includes the liga-
ments as well as the articulations; and
the cranial lesion includes the intrac-
ranial membranes as well as the ar-
ticulations. The ligaments, in their
regulation of movement in the spinal
articulations act as check agents to
voluntary muscular action, and might
be called reciprocal tension liga-
ments. The cranial articulations are
involuntary in their mobility, and
have no intermediate muscular
agency for operation. However, they
possess a special intracranial mem-
Illustrating the flexor profundus
branous tissue that acts not only as
digitorum and flexor longus pollicis
an intermediate agency, but functions
muscles, utilized as leverage in the
also as a reciprocal tension agent that
application of cranial technic.
limits the normal range of their ar-
ticular mobility. This special tissue
consists of the falx cerebri and tento-
Anterior Superior Pole Posterior Pole of
of attachment at Attachment at Occipital
Cristi Galli
Anterior Inferior Pole
of Attachment at
Clinoid Process
Lateral Pole
of Attachment
at Petrous Portion
Illustrating the falx cerebri and tenorium cerebelli as the reciprocal tension
membrane.
Summer 2003
rium cerebelli, which causes move-
ment of the articulations and at the
same time, regulates or limits the nor-
mal, range of articular mobility. This
tissue agent functions somewhat like
that of the tension spring of the bal-
ance wheel of a watch; the tension
spring regulating or limiting the to
and fro movement of the balance
wheel. Hence, the term reciprocal
tension membrane is chosen to de-
scribe the functioning of the intrac-
ranial membranous tissue with the
cranial articulations.
Attention is called to the specific
poles of attachment of the falx cerebri
and the tentorium cerebelli that are
especially adapted to maintain the
normal range of movement of the
basilar articulations. There is an an-
terior superior pole upon the crista
galli of the ethmoid bone; and an an-
terior inferior pole upon the clinoid
processes of the sphenoid bone; also
lateral poles upon the petrous portions
of the temporal bones; and posterior
poles upon the occipital bone.
In respiration, during the period of
inhalation, the anterior superior pole
swings forward, while the anterior
inferior pole swings backward and
upward. At the same period the lat-
eral poles move upward, while the
posterior poles move forward. Dur-
ing the period of exhalation, a reverse
movement occurs at the various poles
of attachment. We might say that dur-
ing the period of inhalation the recip-
rocal tension membrane allows the
crista galli to drop downward, while
it draws the clinoid processes of the
sphenoid backward and upward, the
petrous portions of the temporal
bones upward, and the occipital for-
ward. Then during the period of ex-
halation, the reciprocal tension mem-
brane allows the clinoid processes of
the sphenoid to drop downward and
forward, the petrous portions of the
temporals downward, and the occipi-
tal backward, while it draws the crista
galli of the ethmoid upward.
➻
The AAO Journal/17
The Relation of
Intracranial Membranes
to Venous Flow and
Cerebrospinal Fluid
Fluctuation
One of the most important intrac-
ranial and intraspinal pictures is that
of the dural and arachnoid mem-
branes; the dural wall carrying
venous blood, and the arachnoid fluc-
tuating the cerebrospinal fluid. We
view the superior and inferior longi-
tudinal sinuses formed by the falx
cerebri, and see the venous blood
moving along through the compen-
satory movement of the sagittal su-
ture. We glance laterally to the supe-
rior longitudinal sinus and see the
smaller veins leading from the brain
and apparently emptying against the
flow of the venous blood within the
sinus. We say apparently against the
flow of blood within the sinus, but in
reality it happens to be another de-
sign by a Master Mechanic, to coor-
dinate with the compensatory move-
ment of the sagittal suture. So ar-
ranged that when the sagittal suture
widens posteriorly, the mouths of the
smaller veins empty laterally into the
sinus; and when the sagittal suture
narrows posteriorly the mouths of the
smaller veins assume the forward di-
rection. We then view the lateral si-
nuses along the occipital bone, and
find that there are no sutures to acti-
vate the membranous walls of the ten-
torium cerebelli as an agency to pro-
pel the blood along, but these lateral
sinuses pass over the posterior-infe-
rior (mastoid) angles of the parietal
bones, and these inferior angles move
outward and inward in connection with
the temporal bone during inhalation
and exhalation. This movement draws
the venous blood from the lateral si-
nuses of the occipital bone and carries
it along by membranous activity to the
exits at the jugular foramina.
In this picture we find that the
main venous channels have walls
18/The AAO Journal
decidedly different within the cra-
nium than those in the rest of the
body, and that they find their way out
of the cranium through exits formed
by the articulation of two bones; for
example the jugular foramen. On the
other hand, the arterial walls and the
nerve supply are the same within the
cranium as they are without. In addi-
tion the arterial walls are protected
on their way into the cranium by pass-
ing through individual foramina in
individual bones. Thus we may rea-
son that membranous restriction dis-
turbs the venous flow and the fluc-
tuation of the cerebrospinal fluid.
While cranial lesions may be primary,
the intracranial membranes, includ-
ing the dural and arachnoid, are the
immediate disturbing factors leading
to pathology of the brain.
Incitant Cerebrospinal
Fluid Technique
(text pg. 71)
(a) POSITION: Patient supine-opera-
tor at head. Thenar eminences are
placed on the mastoid portions of the
temporal bones, with thumbs extend-
ing down along the mastoid processes
and fingers locked together beneath
the occiput to secure F.D.P. and F.L.P.
muscle leverage.
MOTION: The mastoid processes
are gently compressed inward and
backward during inspiration to
slightly exaggerate external rotation
of petrous portion while the mastoid
portions are gently compressed in-
ward and backward during expiration
to slightly exaggerate internal rota-
tion of the petrous portion.
(b) POSITION: Patient supine-opera-
tor at head. Hands at sides of head,
tips of mastoid processes between the
distal phalanges of the index and
middle fingers, the thumbs on the
squamous portions of the temporals
above the zygomata.
MOTION: During inspiration the
index fingers gently press the mas-
toid processes inward and backward
to slightly exaggerate external rota-
tion of petrous portions. During ex-
piration the middle fingers bring the
tips of the mastoid processes forward
and outward while the thumbs press
inward and backward on the squa-
mous portions-to slightly exaggerate
internal rotation of the petrous por-
tion. Continue until a change in cir-
culation occurs. This may be deter-
mined by
(1) a sensation of warmth at the
lower occipital and mastoid regions, or,
(2) a change in the diaphragmatic
movement (idling the motor).
Both of which indicate activity in
the lymph channels similar to that
occurring apparently from applica-
tion of the lymphatic pump method.
Lateral fluctuation of
the Cerebrospinal Fluid
The vital functions of the body
operate most effectively under the
influence of the short, rhythmic fluc-
tuation of the cerebrospinal fluid. It
is then that the chemical interchange
between that fluid and the blood is
most freely accomplished, that the
physiological centers in the medulla
function most efficiently, that the
various elements of the cerebrospi-
nal fluid, chemical or otherwise, are
distributed with greatest facility to
their destinations in the tissues of the
body. This quickened and regular
rhythm of low amplitude in the fluc-
tuation is compared by Dr. Sutherland
to the ripples on a vessel of water,
moving concentrically to a fulcrum
when the vessel is subjected to a fine
vibration. The effect upon the body
is evidenced by a warmth coming
from the skin, especially about the
occiput, a velvety feel and a lacy ap-
pearance to the skin, short, even and
effortless respirations, and an ap-
Summer 2003
proach of the body rates and func-
tions toward normal.
This result is produced in various
ways. Reduction in the capacity of the
fourth ventricle in the so-called bulb
compression is one method. If there
is reduced fluctuation of the cere-
brospinal fluid as is present in the
lowered or vagotonic states of the
body the incitant technique is used
until the amplitude and usually the
rate are approximately normal, fol-
lowed by compression of the bulb if
necessary to produce the systemic
reaction. In the cases characterized by
over stimulation or sympathicotonia
the excessive fluctuation is repressed
by steadily holding the temporal
bones, sphenobasilar, vault or sacrum
to reduce their rate and amplitude in
primary respiratory motion, then us-
ing bulb compression if the short,
rhythmic fluctuation does not follow
spontaneously.
Lateral or side-to-side motion of
the cerebrospinal fluid is another
means of bringing the fluctuation down
to the balanced rhythm close to the ful-
crum. The technique is applied with
the position similar to either (a) or (b)
under incitant technique. The tempo-
ral bones are rocked in opposite di-
rections, one in external and the other
in internal rotation, alternating the
position rhythmically. Before starting
the motion it is well to determine by
palpation whether there is already
present any lateral fluctuation and, if
so, the rate and amplitude. This is
evidenced by the alternate or oppo-
site rotation of the temporal bones
just as the respiratory fluctuation
causes them to swing bilaterally ex-
ternally and then internally. If lateral
fluctuation is determined to be
present the technique is administered
in harmony with the already estab-
lished rhythm. If no lateral movement
of the fluid is palpated one is estab-
lished by alternately rocking the
temporals at a rate of approximately
one to one and a half seconds each
direction. The rate will probably need
Summer 2003
Anterior-Interior Poles
Attachment
Lateral Poles of
Attachment
Illustrating the tentorium cerebelli portion in lreation to the reciprocal tension membrane.
to be changed to conform to that as-
sumed by the cranial mechanism as
the fluid starts fluctuating. By add-
ing the lateral to the ever-present res-
piratory movement of the cerebrospi-
nal fluid the fluctuation assumes the
desired short, easy rhythm, and the
system reaction is manifested by the
skin changes and the breathing.
The technique is accomplished
with the thenar eminences and
thumbs placed in the grooves ante-
rior to the mastoid portions and pro-
cesses and posterior to the external
auditory meatuses, these being the
only contacts necessary upon the
skull. The fingers are loosely inter-
laced posterior to the upper cervical
spine. The middle fingers are rolled
back and forth, one upon the other,
providing the motion of the thumbs,
which rocks the temporals. It is im-
perative not to press the temporals
posteriorly, but to turn them like the
cap on a fruit jar without pressure
against one side of the threads. In the
usual case the movement must be al-
most imperceptible. If a stimulating
or incitant effect is desired the am-
plitude of the motion is very slightly
greater than that ordinarily applied.
If the motion is discontinued and then
resumed, it should be in the rhythm
already established. It is well to visu-
alize a long pendulum, gently touched
on each side alternately to start it swing-
Posterior Poles
of Attachment
ing. Its natural rate and rhythm must
be respected if its motion is to be con-
tinued without disturbance.
The technique is continued until the
systemic response occurs, usually in a
shorter time than that required in con-
ventional “compression of the bulb.”❒
Detroit, Michigan
Practice
Needs NMM/OMM
Board Certified/Eligible
Physician
Nestled in the northwestern sub-
urbs of Detroit, Michigan is
ABODE Integrated Medicine,
PLLC. Detroit is among the larg-
est Midwestern cities in the coun-
try offering world class sporting
(Red Wings, Pistons, Lions and Ti-
gers) as well as music, entertain-
ment and theater. At ABODE, we
believe in fostering a science-based
Osteopathic and Holistic medical
approach to health care. We offer
interested NMM/OMM board cer-
tified/eligible physicians a chance
to grow in practice and develop
unique directions and goals. For
more information call Jay Danto at
248/788-3956.
The AAO Journal/19